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Janssen SM, Connelly DM, Shields C, Landry M. Assessing physical function after completing a supervised education and exercise program in adults with type 2 diabetes and exploring exercise motivation at one-year follow up: A case series study. Physiother Theory Pract 2023; 39:2662-2675. [PMID: 35794692 DOI: 10.1080/09593985.2022.2097968] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 04/10/2022] [Accepted: 06/29/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Exercise programs for adults with type 2 diabetes (T2D) improve glycemic control and physical function. However, diabetes complications, disability, and motivation pose challenges for exercise participation. OBJECTIVE The purpose of the study was to: 1) measure change in fasting blood glucose, blood pressure, anthropometrics (i.e. BMI and waist circumference), and physical function (i.e. endurance, agility and balance, upper and lower-body strength and flexibility) after completing an eight-week education and exercise program for adults with T2D; and 2) explore the experience of exercise continuation in people living with T2D at one-year follow-up. METHODS A mixed methods case series design was conducted. Participants were ≥ 18 years and had a clinical diagnosis of T2D (glycated hemoglobin (A1C) ≥ 6.5%). Participants completed two one-hour exercise sessions and one one-hour education session per week for eight weeks. Blood glucose, blood pressure, body mass index (BMI), waist circumference, and physical function were measured at baseline and after completing the program. Follow-up telephone interviews were conducted at one, six, and 12-months and thematic analysis was employed to analyze interviews. RESULTS Twelve participants completed the program. Clinically significant improvements were observed for waist circumference, systolic blood pressure, six-minute walk test (6MWT), timed up-and-go test (TUG), 30-second chair stand test (CST) and arm curls. Three themes emerged from the interviews that described participant reflections and experiences with a supervised education and exercise program for management of their T2D: 1) medical management; 2) lifestyle management; and 3) finding what works. Conclusion: Supervised programming improves physical function and may mitigate disability. Physiotherapists are qualified to assess and treat physical function through education and exercise.
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Affiliation(s)
- Sarah M Janssen
- Health and Rehabilitation Sciences Graduate Program, Faculty of Health Sciences, Western University, London, ON, Canada
| | | | - Chris Shields
- School of Kinesiology, Acadia University, Wolfville, NS, Canada
| | - Mireille Landry
- Women's College Hospital, Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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2
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Eggert EE, Palmer W, Shanjani LI, Gretebeck K, Mahoney JE. Outcomes Associated With Translating Evidence-Based Research Into Practice: The Physical Activity for Lifelong Success Program. J Phys Act Health 2023; 20:1162-1174. [PMID: 37751905 DOI: 10.1123/jpah.2022-0238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/19/2023] [Accepted: 07/30/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Few programs assess for outcomes once translated into practice. The Physical Activity for Lifelong Success program was developed as a center-based public health intervention and shown to improve walking speed and distance among older adults with type 2 diabetes. We adapted the program for community-based delivery by lay leaders to physically inactive older adults. METHODS We followed the Replicating Effective Programs framework to identify community stakeholders, adapt, implement, and evaluate fidelity of delivery in community settings, and plan for maintenance and evolution. Sixteen community sites enrolled 184 adults (mean age 73.5 y, 85% female, 93% White) in 21 workshops. Baseline and postworkshop measures assessed participants' health-related quality of life, physical function, and physical fitness. Data were analyzed using Fisher exact tests, Student t test, and paired linear regression with fixed effects. RESULTS Fidelity testing indicated leader training was sufficient to maintain key elements with delivery. Data from 122 participants showed improvements in chair stands (P < .001), arm curls (P < .001), 2-minute step test (P < .001), sit-and-reach (P = .001), 8-foot up-and-go (P < .001), and 10-m walk (P < .001). CONCLUSIONS Adaptation of Physical Activity for Lifelong Success for implementation by community organizations for physically inactive older adults demonstrates that fidelity and effectiveness can be maintained after program translation.
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Affiliation(s)
- Erin E Eggert
- Wisconsin Institute for Healthy Aging, Madison, WI, USA
| | - Will Palmer
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Lourdes I Shanjani
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Jane E Mahoney
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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3
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Tsai YH, Chuang LL, Lee YJ, Chiu CJ. Behavioral and Psychological Factors in Buffering Diabetes-related Disability Development. Ann Behav Med 2023; 57:1046-1057. [PMID: 37549141 DOI: 10.1093/abm/kaad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Diabetes is associated with disability development. Healthy behaviors and psychosocial support can help patients manage their disease. PURPOSE To examine the role of various behavioral and psychological factors in buffering the effect of diabetes on disability development over time in Taiwanese adults. METHODS Data on 5,131 adults aged ≥50 years were obtained from the Taiwan Longitudinal Study on Aging. A cohort sequential multilevel design was employed to analyze the association between behavioral and psychosocial factors and the risk of disability over a 11-year period. RESULTS In patients with diabetes, having social support and exercising more than six times a week were associated with 4% and 49% reductions in the risk of disability, respectively (βdiabetes*socialsupport = -0.285, p = .006; βdiabetes*exercise3 = -2.612, p = .007). Exercising more than six times a week had an additional significant protective effect against disability development per year (βdiabetes*exercises3*age = -0.241, p = .038). Depression did not significantly interact with diabetes. However, a trajectory analysis revealed that individuals who had both diabetes and depression had the highest disability score from middle age among all participants. CONCLUSIONS Engaging in frequent exercise is the most influential factor for reducing the risk of disability in patients with diabetes. Social support provides an additional benefit for disability prevention in individuals with diabetes.
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Affiliation(s)
- Yi-Hsuan Tsai
- Division of Pulmonary & Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Li-Lun Chuang
- Department of Endocrinology & Metabolism, Lee's Endocrinology Clinic, Pingtung, Taiwan
| | - Yau-Jiunn Lee
- Department of Endocrinology & Metabolism, Lee's Endocrinology Clinic, Pingtung, Taiwan
| | - Ching-Ju Chiu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Hashimoto Y, Takahashi F, Okamura T, Hamaguchi M, Fukui M. Diet, exercise, and pharmacotherapy for sarcopenia in people with diabetes. Metabolism 2023; 144:155585. [PMID: 37156410 DOI: 10.1016/j.metabol.2023.155585] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/17/2023] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Abstract
Diabetes prevalence is increasing rapidly in older people, and sarcopenia is prevalent as a novel complication, particularly in patients with type 2 diabetes mellitus (T2DM). Therefore, sarcopenia prevention and treatment in these people is necessary. Diabetes accelerates sarcopenia through several mechanisms, such as hyperglycemia, chronic inflammation and oxidative stress. The effects of diet, exercise, and pharmacotherapy on sarcopenia in patients with T2DM need to be considered. In diet, low intake of energy, protein, vitamin D, and ω-3 fatty acid are associated with sarcopenia risk. In exercises, although intervention studies in people, especially older and non-obese patients with diabetes, are few, accumulating evidence shows the usefulness of exercise, particularly resistance exercise for muscle mass and strength, and aerobic exercise for physical performance in sarcopenia. In pharmacotherapy, certain classes of anti-diabetes compounds have possibility of preventing sarcopenia. However, much data on diet, exercise, and pharmacotherapy were obtained in obese and non-elderly patients with T2DM, demanding actual clinical data on non-obese and older patients with diabetes.
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Affiliation(s)
- Yoshitaka Hashimoto
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan; Department of Diabetes and Endocrinology, Matsushita Memorial Hospital, 5-55 Sotojima-cho, Moriguchi 570-8540, Japan.
| | - Fuyuko Takahashi
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Takuro Okamura
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Masahide Hamaguchi
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
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5
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Richards EA, Christ SL, Rietdyk S, Teas E, Franks MM. Association of Physical Activity and Gait Speed: Does Context Matter? Am J Lifestyle Med 2023. [DOI: 10.1177/15598276231157311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Background: Physical activity (PA) is associated with gait speed, and both are recognized predictors of important health outcomes. The role of social context, such as PA of one’s spouse, in the association between PA and gait speed is largely unexplored. Methods: In our dyadic study of 69 couples, we objectively assessed each partner’s moderate to vigorous PA (MVPA) and gait speed. Associations of MVPA and gait speed were tested using actor-partner interdependence models in a structural equation modeling framework. Whether partners’ typically exercise together was examined as a moderator of these associations. Results: A nonlinear association was observed where higher MVPA was associated with faster gait speed, but only when MVPA was below average (husbands β = −.517; P = .002; wives β = −.483; P = .009). No moderating effects of exercising together were detected for husbands’ or wives’ MVPA on their own or their partners’ gait speed. Conclusions: In this investigation of couples, the association between MVPA and gait speed emerged only when nonlinear effects were considered. Findings suggest that the PA and gait speed association may be more nuanced than previously examined. Additional consideration of contextual factors that may alter the complex association between MVPA and gait speed is warranted.
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Affiliation(s)
| | - Sharon L. Christ
- Department of Human Development and Family Science and Department of Statistics, Purdue University, West Lafayette, IN, USA
| | - Shirley Rietdyk
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA
| | - Elizabeth Teas
- Department of Human Development and Family Science, Purdue University, West Lafayette, IN, USA
| | - Melissa M. Franks
- Department of Human Development and Family Science, Purdue University, West Lafayette, IN, USA
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Seah SJ, Harding SC, Wang J, Aw S, Lam J, Lim RBT. Effectiveness of a Cluster Randomized Controlled Trial Involving Community-Based Intervention for Older Adults With Type 2 Diabetes Mellitus in Singapore. DIABETES EDUCATOR 2022; 48:505-521. [DOI: 10.1177/26350106221125695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: The purpose of the study was to investigate the effectiveness of a community-based intervention on improving knowledge about diabetes, self-care behaviors, and glycemic control among older adults with type 2 diabetes mellitus (T2DM) in Singapore, a country in Asia with a high prevalence of diabetes. Methods: A 3-arm cluster randomized controlled trial involving community-dwelling older adults ages 55 to 99 with T2DM was conducted. Intervention group 1 and 2 participants received a 12-session intervention program designed to teach knowledge and practical skills in diabetes self-care with psychological techniques for behavioral change like problem solving, goal setting, and motivational interviewing. In addition, intervention group 2 participants received a glucometer and a supply of accessories each. The control group received routine care from their health care providers. Results: Compared to the control group, intervention group 2 reported an increase in medication adherence and self-monitoring of blood glucose (SMBG) at 3-month follow-up and increased knowledge about diabetes and self-care behavior in general diet control at 6-month follow-up. Conclusions: The community-based intervention should be extended to more older adults with T2DM in the community. Glucometers and accessories could be provided at subsidized rates or be made free contingent on older adults’ income status to overcome the barrier of performing SMBG.
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Affiliation(s)
- Siang Joo Seah
- Health Systems & Behavioural Sciences, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore city, Singapore
- Centre for Population Health Research and Implementation, Regional Health System, Singapore Health Services Pte Ltd, Singapore city, Singapore
| | | | - Jing Wang
- Tsao Foundation, Singapore city, Singapore
| | - Su Aw
- Tsao Foundation, Singapore city, Singapore
| | | | - Raymond Boon Tar Lim
- Health Systems & Behavioural Sciences, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore city, Singapore
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7
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Harris LK, Skou ST, Juhl CB, Jäger M, Bricca A. Recruitment and retention rates in randomised controlled trials of exercise therapy in people with multimorbidity: a systematic review and meta-analysis. Trials 2021; 22:396. [PMID: 34127042 PMCID: PMC8204443 DOI: 10.1186/s13063-021-05346-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 05/30/2021] [Indexed: 12/18/2022] Open
Abstract
AIM To quantify recruitment, retention and differential retention rates and associated trial, participant and intervention characteristics in randomised controlled trials (RCTs) evaluating the effect of exercise therapy in people with multimorbidity. DATA SOURCES MEDLINE, EMBASE, CINAHL and CENTRAL from 1990 to April 20, 2020. STUDY SELECTION RCTs including people with multimorbidity comparing exercise therapy with a non-exposed comparator group reporting at least one of the following outcomes: physical function, health-related quality of life, depression symptoms, or anxiety symptoms. DATA EXTRACTION AND SYNTHESIS Recruitment rates (proportion of people randomised/proportion of people eligible), retention rates (proportion of people providing the outcomes of interest/proportion randomised) and differential retention rates (difference in proportion of people providing the outcomes in the intervention group and comparator group) were calculated. Meta-analysis using a random-effects model was used to estimate pooled proportions. Methodological quality was assessed using Cochrane ´Risk of Bias tool 2.0´ for individual studies, and the GRADE approach was used to assess the overall quality of the evidence. RESULTS Twenty-three RCTs with 3363 people were included. The pooled prevalence for recruitment rate was 75% (95%CI 66 to 84%). The pooled prevalence for retention rate was 90% (95%CI 86 to 94%) at the end of the intervention (12 weeks; interquartile range (IQR) (12 to 12)). Meta-regression analyses showed that increasing age and including a higher proportion of people with hypertension was associated with lower retention rates. Retention rates did not differ between the intervention and comparator groups. The overall quality of the evidence was deemed very low. CONCLUSION Three in four eligible people with multimorbidity were randomised to RCTs using exercise therapy, of which nine out of 10 provided end of treatment outcomes with no difference seen between the intervention and comparison groups. However, the results must be interpreted with caution due to large differences between the included studies. TRIAL REGISTRATION ClinicalTrials.gov CRD42020161329 . Registered on 28 April 2020.
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Affiliation(s)
- Lasse K. Harris
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense M, Denmark
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
| | - Søren T. Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense M, Denmark
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
| | - Carsten B. Juhl
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense M, Denmark
- Department of Physiotherapy and Occupational Therapy, University Hospital of Copenhagen Herlev and Gentofte, Copenhagen, Denmark
| | - Madalina Jäger
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense M, Denmark
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
| | - Alessio Bricca
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense M, Denmark
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
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8
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Nicolini C, Nelson AJ. Current Methodological Pitfalls and Caveats in the Assessment of Exercise-Induced Changes in Peripheral Brain-Derived Neurotrophic Factor: How Result Reproducibility Can Be Improved. FRONTIERS IN NEUROERGONOMICS 2021; 2:678541. [PMID: 38235217 PMCID: PMC10790889 DOI: 10.3389/fnrgo.2021.678541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/04/2021] [Indexed: 01/19/2024]
Abstract
Neural mechanisms, such as enhanced neuroplasticity within the motor system, underpin exercise-induced motor improvements. Being a key mediator of motor plasticity, brain-derived neurotrophic factor (BDNF) is likely to play an important role in mediating exercise positive effects on motor function. Difficulties in assessing brain BDNF levels in humans have drawn attention to quantification of blood BDNF and raise the question of whether peripheral BDNF contributes to exercise-related motor improvements. Methodological and non-methodological factors influence measurements of blood BDNF introducing a substantial variability that complicates result interpretation and leads to inconsistencies among studies. Here, we discuss methodology-related issues and approaches emerging from current findings to reduce variability and increase result reproducibility.
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Affiliation(s)
| | - Aimee J. Nelson
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
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9
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Orozco-Beltrán D, Artola-Menéndez S, Hormigo-Pozo A, Cararach-Salami D, Alonso-Jerez JL, Álvaro-Grande E, Villabrille-Arias C, de Toro-Santos FJ, Galindo-Puerto MJ, Marín-Jiménez I, Gómez-García A, Ledesma-Rodriguez R, Fernández G, Ferreira de Campos K. Healthcare experience among patients with type 2 diabetes: A cross-sectional survey using the IEXPAC tool. ENDOCRINOLOGY DIABETES & METABOLISM 2021; 4:e00220. [PMID: 33855220 PMCID: PMC8029499 DOI: 10.1002/edm2.220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/10/2020] [Accepted: 12/12/2020] [Indexed: 12/15/2022]
Abstract
Aim To assess the experience with health care among patients with type 2 diabetes (T2DM) and to evaluate patients’ demographic variables and healthcare‐related characteristics which may affect their experience. Methods A cross‐sectional survey was delivered to T2DM adults. Patient experiences were assessed with the ‘Instrument for Evaluation of the Experience of Chronic Patients’ (IEXPAC) questionnaire, a validated 12‐item survey, which describes patient experience within the last 6 months (items 1–11) and hospitalization in the last 3 years (item 12), with possible scores ranging from 0 (worst) to 10 (best experience). Results A total of 451 T2DM patients responded to the survey (response rate 72.3%; mean age 69.5 ± 10.1 years, 67.8% men). The mean overall IEXPAC score was 5.92 ± 1.80. Mean scores were higher for productive interactions (7.92 ± 2.15) and self‐management (7.08 ± 2.27) than for new relational model (1.72 ± 2.01). Only 32.8% of patients who had been hospitalized in the past 3 years reported having received a follow‐up call or visit after discharge. Multivariate analyses identified that regular follow‐up by the same physician and follow‐up by a nurse were associated with a better patient experience. Continuity of healthcare score was higher only in those patients requiring help from others. Conclusions The areas of T2DM care which may need to be addressed to ensure better patient experience are use of the Internet, new technologies and social resources for patient information and interaction with healthcare professionals, closer follow‐up after hospitalization, and a comprehensive multidisciplinary approach with regular follow‐up by the same physician and a nurse.
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Affiliation(s)
| | - Sara Artola-Menéndez
- José Marvá Heath Care Center SED (Spanish Diabetes Society) Diabetes Group Madrid Spain
| | | | | | | | | | | | | | - María José Galindo-Puerto
- Internal Medicine Department Clinic University Hospital Valencia Spain.,Research Department SEISIDA (Spanish AIDS Multidisciplinary Society Madrid Spain
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10
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Mora Pinzon MC, Myers S, Renken J, Eggert E, Chewning B, Mahoney JE. Essential elements to "design for dissemination" within a research network-a modified Delphi study of the Community-Academic Aging Research Network (CAARN). Implement Sci Commun 2021; 2:18. [PMID: 33579395 PMCID: PMC7881665 DOI: 10.1186/s43058-021-00122-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 02/01/2021] [Indexed: 11/28/2022] Open
Abstract
Background The Community-Academic Aging Research Network (CAARN) was developed in 2010 to build partnerships, facilitate research, and ultimately accelerate the pace of development, testing, and dissemination of evidence-based programs related to healthy aging. CAARN has facilitated development and testing of 32 interventions, two of which are being packaged for scale-up, and three of which are being scaled up nationally by non-profit organizations. The purpose of this study is to describe CAARN’s essential elements required to replicate its success in designing for dissemination. Methods We conducted a modified Delphi technique with 31 participants who represented CAARN’s organization (staff and Executive Committee) and academic and community partners. Participants received three rounds of a web-based survey to rate and provide feedback about the importance of a list of potential key elements compiled by the authors. The criterion for establishing consensus was 80% of responses to consider the element to be extremely or very important. Results Response rate was 90% in Round 1, 82% in Round 2, and 87% in Round 3. A total of 115 items were included across rounds. Overall, consensus was achieved in 77 (67%) elements: 8 of 11 elements about academic partners, 8 of 11 about community partners, 29 of 49 about the role of the community research associate, 16 of 21 about the role of the director, 9 of 17 about the purveyor (i.e., the organization that scales up an intervention with fidelity), and 7 of 7 about the overall characteristics of the network. Conclusions The development of evidence-based programs designed for dissemination requires the involvement of community partners, the presence of a liaison that facilitates communications among academic and community stakeholders and a purveyor, and the presence of a pathway to dissemination through a relationship with a purveyor. This study delineates essential elements that meet the priorities of adopters, implementers, and end-users and provide the necessary support to community and academic partners to develop and test interventions with those priorities in mind. Replication of these key elements of the CAARN model may facilitate quicker development, testing, and subsequent dissemination of evidence-based programs that are feasible to implement by community organizations. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00122-z.
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Affiliation(s)
- Maria C Mora Pinzon
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA. .,Department of Family Medicine and Community Health. School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA.
| | - Shannon Myers
- Wisconsin Institute for Healthy Aging, Madison, WI, USA
| | - Jill Renken
- Wisconsin Institute for Healthy Aging, Madison, WI, USA
| | - Erin Eggert
- Wisconsin Institute for Healthy Aging, Madison, WI, USA
| | - Betty Chewning
- School of Pharmacy, University of Wisconsin - Madison, Madison, WI, USA
| | - Jane E Mahoney
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
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11
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Seah SJ, Zheng H, Lim RBT. Efficacy of community-based self-care interventions to improve biophysical, psychosocial or behavioural outcomes among community-dwelling older adults with type 2 diabetes: A systematic review and meta-analysis. Diabetes Res Clin Pract 2020; 169:108411. [PMID: 32898575 DOI: 10.1016/j.diabres.2020.108411] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/23/2020] [Accepted: 08/27/2020] [Indexed: 01/04/2023]
Abstract
AIMS This review assessed the efficacy of self-care interventions to improve biophysical, psychosocial or behavioural outcomes among older adults with diabetes. METHODS Computerised and manual searches were performed. A total of 18 randomised control trials were included in the review, of which eight were subsequently included in the meta-analysis. RESULTS Most studies were from the United States of America and adopted a collaborative approach with participants. The specific needs of older adults were often not considered, and there was a predominance of biophysical measures. Meta-analysis revealed that among intervention condition participants, there were improvements in HbA1c (pooled weighted mean difference (WMD) -0.33, 95%CI -0.48 to -0.17), systolic blood pressure (WMD -1.55, 95%CI -2.93 to -0.18), diastolic blood pressure (WMD -1.41 95%CI -2.08 to -0.20), triglyceride (WMD -13.25, 95%CI -23.31 to -3.20), high-density lipoprotein (WMD 2.05, 95%CI 1.04 to 3.06) and Diabetes Self-Care Activities score (mean 4.10, 95%CI 3.11 to 5.10) compared to the control group. There was no significant change for low-density lipoprotein (WMD -5.93, 95%CI -12.08 to 0.22). CONCLUSIONS While continuing to adopt a collaborative approach, future self-care interventions should incorporate psychosocial and behavioural outcomes, consider the specific needs of older adults, and focus on more ethnically diverse populations.
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Affiliation(s)
- Siang Joo Seah
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore 117549, Singapore City, Singapore.
| | - Huili Zheng
- Health Promotion Board, Singapore, 3 Second Hospital Ave, Singapore 168937, Singapore City, Singapore.
| | - Raymond Boon Tar Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore 117549, Singapore City, Singapore.
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12
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Bricca A, Harris LK, Jäger M, Smith SM, Juhl CB, Skou ST. Benefits and harms of exercise therapy in people with multimorbidity: A systematic review and meta-analysis of randomised controlled trials. Ageing Res Rev 2020; 63:101166. [PMID: 32896665 PMCID: PMC7116122 DOI: 10.1016/j.arr.2020.101166] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/06/2020] [Accepted: 08/26/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To investigate the benefits and harms of exercise therapy on physical and psychosocial health in people with multimorbidity. DESIGN Systematic review of randomised controlled trials (RCTs). Data sources MEDLINE, EMBASE, CENTRAL and CINAHL from 1990 to April 20th, 2020 and Cochrane reviews on the effect of exercise therapy for each of the aforementioned conditions, reference lists of the included studies, the WHO registry and citation tracking on included studies in Web of Science. ELIGIBILITY CRITERIA FOR STUDY SELECTION RCTs investigating the benefit of exercise therapy in people with multimorbidity, defined as two or more of the following conditions: osteoarthritis (of the knee or hip), hypertension, type 2 diabetes, depression, heart failure, ischemic heart disease, and chronic obstructive pulmonary disease on at least one of the following outcomes: Health-related quality of life (HRQoL), physical function, depression or anxiety. SUMMARY AND QUALITY OF THE EVIDENCE Meta-analyses using a random-effects model to assess the benefit of exercise therapy and the risk of non-serious and serious adverse events according to the Food and Drug Administration definition. Meta-regression analyses to investigate the impact of pre-specified mediators of effect estimates. Cochrane 'Risk of Bias Tool' 2.0 and the GRADE assessment to evaluate the overall quality of evidence. RESULTS Twenty-three RCTs with 3363 people, testing an exercise therapy intervention (mean duration 13.0 weeks, SD 4.0) showed that exercise therapy improved HRQoL (standardised mean difference (SMD) 0.37, 95 % CI 0.14 to 0.61) and objectively measured physical function (SMD 0.33, 95 % CI 0.17 to 0.49), and reduced depression symptoms (SMD -0.80, 95 % CI -1.21 to -0.40) and anxiety symptoms (SMD -0.49, 95 % CI -0.99 to 0.01). Exercise therapy was not associated with an increased risk of non-serious adverse events (risk ratio 0.96, 95 % CI 0.53-1.76). By contrast, exercise therapy was associated with a reduced risk of serious adverse events (risk ratio 0.62, 95 % CI 0.49 to 0.78). Meta-regression showed that increasing age was associated with lower effect sizes for HRQoL and greater baseline depression severity was associated with greater reduction of depression symptoms. The overall quality of evidence for all the outcomes was downgraded to low, mainly due to risk of bias, inconsistency and indirectness. CONCLUSIONS Exercise therapy appears to be safe and to have a beneficial effect on physical and psychosocial health in people with multimorbidity. Although the evidence supporting this was of low quality, it highlights the potential of exercise therapy in the management and care of this population.
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Affiliation(s)
- Alessio Bricca
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense M, Denmark; Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark.
| | - Lasse K Harris
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense M, Denmark; Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark
| | - Madalina Jäger
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense M, Denmark; Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark
| | - Susan M Smith
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Carsten B Juhl
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense M, Denmark; Department of Physiotherapy and Occupational Therapy, University Hospital of Copenhagen Herlev and Gentofte, Copenhagen, Denmark
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense M, Denmark; Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark
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Choi NG, DiNitto DM, Sullivan JE, Choi BY. Physical Activity Frequency Among Older Adults With Diabetes or Prediabetes: Associations With Sociodemographics, Comorbidity, and Medical Advice. J Aging Phys Act 2020; 28:641-651. [PMID: 31952046 DOI: 10.1123/japa.2019-0338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/22/2019] [Accepted: 12/07/2019] [Indexed: 11/18/2022]
Abstract
To examine the differences in physical activity (PA) between older adults with and without diabetes/prediabetes and the correlates of PA frequency and associations between medical advice on PA and/or diet/weight loss and increasing PA among those with diabetes/prediabetes. Multinomial and binary logistic regression models using 2016-2017 National Health Interview Survey data (N = 4,860 aged 65+ years with diabetes/prediabetes). About 44.2% of those with diabetes/prediabetes, compared with 48.1% of a matched sample without, engaged in any PA three plus times a week. The low PA group (PA frequency was zero to two times a week) was more socioeconomically disadvantaged and had more chronic illnesses than the medium (three to four times a week) or high (five plus times a week) PA groups. Any PA and/or diet/weight loss medical advice was associated with two to three times higher odds of increasing PA. Health care providers should consider prescribing PA and/or diet/weight loss for patients with diabetes/prediabetes.
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Mahoney JE, Pinzon MM, Myers S, Renken J, Eggert E, Palmer W. The Community-Academic Aging Research Network: A Pipeline for Dissemination. J Am Geriatr Soc 2020; 68:1325-1333. [PMID: 32039476 DOI: 10.1111/jgs.16363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/17/2019] [Accepted: 01/16/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND/OBJECTIVES The Community-Academic Aging Research Network (CAARN) was created to increase the capacity and effectiveness of Wisconsin's Aging Network and the University of Wisconsin to conduct community-based research related to aging. The purpose of this article is to describe CAARN's infrastructure, outcomes, and lessons learned. DESIGN Using principles of community-based participatory research, CAARN engages stakeholders to participate in the design, development, and testing of older adult health interventions that address community needs, are sustainable, and improve health equity. SETTING Academic healthcare and community organizations. PARTICIPANTS Researchers, community members, and community organizations. INTERVENTION CAARN matches academic and community partners to develop and test evidence-based programs to be distributed by a dissemination partner. MEASUREMENTS Number of partnerships and funding received. RESULTS CAARN has facilitated 33 projects since its inception in 2010 (30 including rural populations), involving 46 academic investigators, 52 Wisconsin counties, and 1 tribe. These projects have garnered 52 grants totaling $20 million in extramural and $3 million in intramural funding. Four proven interventions are being prepared for national dissemination by the Wisconsin Institute for Healthy Aging: one to improve physical activity; one to reduce bowel and bladder incontinence; one to reduce sedentary behavior; and one to reduce falls risk among Latinx older adults. Additionally, one intervention to improve balance using a modified tai chi program is being disseminated by another organization. CONCLUSION CAARN's innovative structure creates a pipeline to dissemination by designing for real-world settings through inclusion of stakeholders in the early stages of design and by packaging community-based health interventions for older adults so they can be disseminated after the research has been completed. These interventions provide opportunities for clinicians to engage with community organizations to improve the health of their patients through self-management. J Am Geriatr Soc 68:1325-1333, 2020.
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Affiliation(s)
- Jane E Mahoney
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Maria Mora Pinzon
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Shannon Myers
- Wisconsin Institute for Health Aging, Madison, Wisconsin
| | - Jill Renken
- Wisconsin Institute for Health Aging, Madison, Wisconsin
| | - Erin Eggert
- Wisconsin Institute for Health Aging, Madison, Wisconsin
| | - Will Palmer
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
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